| NPI | 1639331804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08744500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD489847C) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2025-05-30 |